Provider Demographics
NPI:1558953398
Name:PETRICK, LINDSEY NICHOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:NICHOLE
Last Name:PETRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4926 N ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-8748
Mailing Address - Country:US
Mailing Address - Phone:208-755-1641
Mailing Address - Fax:
Practice Address - Street 1:13403 N GOVERNMENT WAY STE 319
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-8905
Practice Address - Country:US
Practice Address - Phone:208-755-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID416811041C0700X
ID37776104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker